Frequencies and characteristics of misdiagnoses in people with multiple sclerosis

A study performed in Argentina evaluated the frequency of misdiagnoses made in people with multiple sclerosis and recorded the diseases with which it was confused. The results indicated that the frequency of misdiagnoses was 16%.

The authors began by considering that surveys have been done in Europe and North America to determine the frequency of diagnostic errors that preceded a confirmed diagnosis of multiple sclerosis. For example, Solomon and colleagues reported that between 30 and 67 percent of people referred to specialist centers with a suspected diagnosis of multiple sclerosis did not have the disease. Another case analysis indicated that more than 50% of individuals in whom a diagnosis of multiple sclerosis was confirmed had previously had it wrong for at least 3 years, and more than 5% had had it wrong for more than 20 years. The same kind of analysis had never been done in South America where there are health care systems that have different structures and resources, compared to the geographic areas mentioned above. Therefore, they performed research with the aim of defining the frequency of misdiagnosis in people with multiple sclerosis and identifying any factors that come into play in such errors. In a Multiple Sclerosis Referral Center, medical records of individuals evaluated between April 2013 and March 2021 were retrospectively analyzed. The following were recorded: diagnosis made prior to access to the Center, final diagnosis, clinical, paraclinical and demographic characteristics of each subject, and prescribed treatments. A total of 736 cases were identified, of which 572 obtained a diagnosis of multiple sclerosis at the Center. Of these, 89 (16%) had been previously misdiagnosed. Females were 83% more likely to have this problem, with a statistically significant difference (p=0.034) compared to males. The most frequent misdiagnoses received by multiple sclerosis patients were: brain vessel disease, radiologically isolated syndrome, and headache. Seventy-four (83%) of the patients who had been misdiagnosed had presented with atypical demyelination syndrome, 62 (70%) had atypical images on MRI, and 54 (61%) had been prescribed disease-modifying medication.

In their conclusions, the authors pointed out that 16% of subjects who subsequently received a diagnosis of multiple sclerosis had previously been misdiagnosed, and this problem occurred more often in women. They recommended careful application of McDonald’s criteria to prevent diagnostic errors.

Source:  The frequency and characteristics of multiple sclerosis misdiagnosis in Latin America: A referral center study in Buenos Aires, Argentina. Multiple Sclerosis Journal 2022 Aug;28(9):1373-1381

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